Sample Record for 2026-03-18-49
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000561 DEA: 010J8904 EFIS: 0119000119
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-3.9/6.0
Work Description: HOT MIX ASPHALT, AGGREGATE BASE, AND STRUCTURAL CONCRETE.
Location Description: HUMBOLDT COUNTY AT CARLOTTA FROM 0.2 MILE WEST OF FISHER ROAD TO 0.2 MILE WEST OF WILDER ROAD
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: 200 Dinsmore Dr., Fortuna, CA 95540
Resident Engineer: Cody Long Structure Rep.: Jordan St. John
Sample Information
DIME Sample ID: 2026-03-18-49
TL Number from the TL Form:
Sample Submitted By Organization: BSK Associates
Sample Organization Contact: (925) 765-9483
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 03/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/18/2026
The quantity of what the sample constitutes: 1 bulk bag
A brief description of the sample: 3/8" x No.8 Aggregates
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pinnacle Prestress, Inc.
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-54-0021
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
